Matching delayed infusion auto-programs with manually entered infusion programs

ABSTRACT

A system and method that identifies delayed infusion programs at an infusion pump or with a first computer and an infusion pump. The first computer receives an infusion auto-program from a remote source, transmits the infusion auto-program to the infusion pump, and sends a stale auto-program to the infusion pump. The infusion pump receives a manual infusion program, saves and executes the manual infusion program, and compares the stale auto-program to the manual infusion program to identify potential matches between the stale auto-program and the manual infusion program. The infusion pump evaluates the potential matches and determines if the potential matches are within a predefined tolerance, continues to execute the at least one manual infusion program on the infusion pump if the potential matches are within the predefined tolerance, and remotely saves differences in the manual infusion program and the at stale auto-program in a remote server for later analysis.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.17/017,460, filed Sep. 10, 2020, which is a continuation of U.S.application Ser. No. 16/296,806, filed Mar. 8, 2019, now U.S. Pat. No.10,799,632, which is a continuation of U.S. application Ser. No.15/511,193, filed Mar. 14, 2017, now U.S. Pat. No. 10,238,799, which isthe U.S. national stage of International Application No.PCT/US2015/050128, filed Sep. 15, 2015, which is a continuation of U.S.application Ser. No. 14/853,198, filed Sep. 14, 2015, now U.S. Pat. No.9,539,383, which claims the benefit of U.S. Application No. 62/050,536,filed Sep. 15, 2014, each of which is incorporated herein by referencein its entirety.

BACKGROUND OF THE INVENTION Field of the Invention

The present disclosure relates to infusion pump programming analysis.Specifically, disclosed is a system and method that matches delayedinfusion auto-programs with manually entered infusion programs andanalyzes differences therein. At least one embodiment optionallydisplays an error message at the infusion pump if the manual orauto-program request is inconsistent with a drug library. At least oneembodiment analyzes the differences in the manual program and the staleauto-program and saves the results of the analysis locally in the pumpor remotely in a remote server for subsequent review and/or data mining.

Description of the Related Art

Infusion pumps are commonplace among medical devices in modernhospitals. The pumps serve as a useful tool for delivering medication topatients, and are particularly beneficial for their great accuracy indelivering medication at a specific rate and dose. Moreover, medicalfacilities have enabled hospital caregivers, such as nurses, to delivermedication to patients using auto-programming features available for theinfusion pump. Although auto-programming features may reduce errors mademanually by hospital caregivers, medical facilities still struggle withidentifying and responding to errors made when using an infusion pump.In a conventional auto-programmable pump, error codes and messages maybe sent surreptitiously from the pump to other areas of the medicalnetwork, but are not immediately accessible to a hospital caregiversubmitting an auto-program request at the infusion pump. Furthermore,these error codes often do not specifically describe the error to thecaregiver at the pump so that the caregiver may immediately respond tothe error.

In addition, known systems do not analyze potential acceptable events ifthe manual program entered by the caregiver while waiting for anauto-program to arrive at the infusion pump is acceptable. Known systemsdo not store or analyze the differences between the manual program andthe auto-program to determine response times, quality of data entry bythe caregiver, and do not learn from caregivers that are at the point ofcare and thus may purposefully enter a different infusion rate orvolume. Thus, there is a need for system and method that matches delayedinfusion auto-programs with manually entered infusion programs andanalyzes differences therein.

BRIEF SUMMARY OF THE INVENTION

The following presents a simplified summary of the present disclosure inorder to provide a basic understanding of some aspects of thedisclosure. This summary is not an extensive overview of the disclosure.It is not intended to identify key or critical elements of thedisclosure or to delineate the scope of the disclosure. The followingsummary merely presents some concepts of the disclosure in a simplifiedform as a prelude to the more detailed description provided below.

Certain aspects disclose a method, comprising: receiving, at an infusionpump, an auto-programming request, wherein the auto-programming requestcomprises IV drug container information, infusion pump information, andoptionally patient wristband information; receiving, at the infusionpump, infusion program settings; comparing, at the infusion pump, theinfusion program settings with drug library program settings, whereinthe drug library program settings are provided in a drug library storedat the infusion pump; determining, at the infusion pump, that theinfusion program settings are inconsistent with the drug library programsettings based on the comparing; generating, at the infusion pump, anerror message based on the determining; and displaying, at the infusionpump, a screen, wherein the screen comprises the error message and arecommended action.

Certain other aspects disclose a non-transitory computer-readablestorage medium having computer-executable program instructions storedthereon that, when executed by a processor, cause the processor to:receive an auto-programming request, wherein the auto-programmingrequest comprises patient wristband information, IV drug containerinformation, infusion pump information, and optionally patient wristbandinformation; receive infusion program settings; compare the infusionprogram settings with drug library program settings, wherein the druglibrary program settings are provided in a drug library stored at theinfusion pump; determine that the infusion program settings areinconsistent with the drug library program settings based on thecomparing; generate an error message based on the determining; anddisplay a screen on the infusion pump, wherein the screen comprises theerror message and a recommended action; and receive a command inresponse to the error message and the suggested action.

Certain other aspects disclose an apparatus comprising: a memory; aprocessor, wherein the processor executes computer-executable programinstructions which cause the processor to: receive an auto-programmingrequest, wherein the auto-programming request comprises patientwristband information, IV bag information, infusion pump information,and optionally patient wristband information; receive infusion programsettings; compare the infusion program settings with drug libraryprogram settings, wherein the drug library program settings are providedin a drug library stored at the infusion pump; determine that theinfusion program settings are inconsistent with the drug library programsettings based on the comparing; generate an error message based on thedetermining; and display a screen at the infusion pump, wherein thescreen comprises the error message and a recommended action.

One or more embodiments of the invention include a system and methodthat identify delayed infusion programs at an infusion pump. At leastone embodiment of the invention includes a first computer including acomputer network interface and at least one infusion pump. In one ormore embodiments, the first computer communicates with the at least oneinfusion pump via the computer network interface.

By way of one or more embodiments, the first computer receives at leastone infusion auto-program from a remote source. In at least oneembodiment, the remote source may include hospital information system,pharmacy information system or medication administration system and thefirst computer may include a medication management unit (MMU), such as aserver equipped with Hospira MedNet™ software. In one or moreembodiments, the at least one infusion auto-program may include one ormore of IV drug container information, infusion pump information, andinfusion program settings.

In at least one embodiment, the first computer transmits the at leastone infusion auto-program to the at least one infusion pump. In one ormore embodiments, the first computer may queue the at least one infusionauto-program when the first computer is unable to transmit the at leastone infusion auto-program to the at least one infusion pump. In at leastone embodiment, the first computer sends the at least one staleauto-program to the at least one infusion pump when the at least oneinfusion pump communicates with the first computer.

According to one or more embodiments of the invention, at least oneinfusion pump may receive at least one manual infusion program from acaregiver. In one or more embodiments, the at least one manual infusionprogram may include one or more of a completed manual infusion programor a running manual infusion program. In one or more embodiments, the atleast one infusion pump saves and executes the at least one manualinfusion program received from the caregiver, and compares the at leastone stale auto-program to the at least one manual infusion program. Inat least one embodiment of the invention, the at least one manualinfusion program may be manually selected by a caregiver at the pumpfrom a plurality of protocols that are predefined and provided in a druglibrary stored in the memory of the at least one infusion pump. In oneor more embodiments, the comparison may be based on an approximate timeof infusion administration and parameter matching logic includinginfusion administration parameters and infusion pump operatingparameters.

By way of at least one embodiment, the at least one infusion pumpcompares the infusion pump operating parameters and the infusionadministration parameters to identify potential matches between the atleast one stale auto-program and the at least one manual infusionprogram. In one or more embodiments, the at least one infusion pump mayevaluate the potential matches using one or more configurable rules anddetermines if the potential matches are within a predefined tolerance.In at least one embodiment, the at least one infusion pump may continueto execute the at least one manual infusion program on the at least oneinfusion pump if the potential matches are within the predefinedtolerance.

In one or more embodiments, the at least one infusion pump savesdifferences in the at least one manual infusion program and the at leastone stale auto-program locally in a processor of the pump and/orremotely in the remote server. In at least one embodiment, the at leastone infusion pump locally and/or remotely saves a first event alertindicating the at least one manual infusion program as an acceptablepotential match of the potential matches, and locally and/or remotelysaves a second event alert indicating the at least one auto-program asan un-executed program because the at least one manual infusion programis an acceptable potential match.

According to at least one embodiment of the invention, the at least oneinfusion pump may include an input screen, such that the caregiver mayinput the at least one manual infusion program via the input screen.

In one or more embodiments, the at least one infusion pump may saveidentification data of the caregiver locally and/or remotely in theremote server. In at least one embodiment of the invention, the at leastone infusion pump compares the at least one manual infusion program fromthe caregiver to the at least one stale auto-program to determine ascoring of accuracy. In at least one embodiment, the scoring of accuracymay include an acceptability level of the at least one manual infusionprogram from the caregiver.

By way of one or more embodiments of the invention, the at least oneinfusion pump may generate at least one report from the comparison ofthe at least one manual infusion program to the at least one staleauto-program. In at least one embodiment, the report generated by the atleast one infusion pump may include one or more of a time differentialbetween completion time of the at least one manual infusion program andcompletion time of the at least one stale auto-program, a scoring ofaccuracy including an acceptability level between infusionadministration parameters of the at least one manual infusion programand the at least one stale auto-program, and a rating of the caregiver.

In one or more embodiments, the at least one infusion pump may transmitthe at least one manual infusion program from the caregiver to the firstcomputer. In at least one embodiment, the first computer may save the atleast one manual infusion program from the caregiver and may saveidentification data of the caregiver. In one or more embodiments, thefirst computer may compare the at least one manual infusion program fromthe caregiver to the at least one stale auto-program to determine ascoring of accuracy. In at least one embodiment, the scoring of accuracymay include an acceptability level of the at least one manual infusionprogram from the caregiver, or analyze and save the program for reviewif the outcome for the patient results in improved care for example.

By way of one or more embodiments of the invention, the first computermay generate at least one report from the comparison of the at least onemanual infusion program to the at least one stale auto-program. In atleast one embodiment, the report generated by the first computer mayinclude one or more of a time differential between completion time ofthe at least one manual infusion program and completion time of the atleast one stale auto-program, a scoring of accuracy including anacceptability level between infusion administration parameters of the atleast one manual infusion program and the at least one staleauto-program, and a rating of the caregiver. Data mining may be utilizedto determine the manual programs that result in improved outcomes, lessdrug use, shorter patient stay or any other parameter.

The details of these and other embodiments of the disclosure are setforth in the accompanying drawings and description below. Other featuresand advantages of aspects of the disclosure will be apparent from thedescription, drawings, and claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other aspects, features and advantages of at least oneembodiment of the invention will be more apparent from the followingmore particular description thereof, presented in conjunction with thefollowing drawings wherein:

FIG. 1 shows an illustrative schematic diagram of a network forcommunication with an infusion pump;

FIG. 2 shows an illustrative flowchart for auto-programming an infusionpump without an error being encountered;

FIG. 3 shows an illustrative flowchart for auto-programming an infusionpump with an error being encountered and handled, and acceptable manualprograms according to the present invention;

FIG. 4 shows an illustrative infusion pump;

FIGS. 5 and 6 show illustrative flow diagrams for displaying errormessages and acceptable manual programs at an infusion pump;

FIG. 7 shows an illustrative flowchart for displaying error messages andacceptable manual programs.

DETAILED DESCRIPTION OF THE INVENTION

The following description is of the best mode presently contemplated forcarrying out at least one embodiment of the invention. This descriptionis not to be taken in a limiting sense, but is made merely for thepurpose of describing the general principles of the invention. The scopeof the invention should be determined with reference to the claims.

FIG. 1 illustrates an exemplary schematic diagram of a system foradministering medication via an infusion pump. The medication managementsystem (MMS) shown in FIG. 1 comprises a medication management unit(MMU) 3108 and a medical device, such as infusion pump 3130, typicallyoperating in conjunction with one or more information systems orcomponents of a hospital environment.

Intravenous (IV) fluid(s) and/or medication(s) 3100 in containers 3102may be administered to a patient 3104 using the system shown in FIG. 1 .Although the system shown in exemplary FIG. 1 utilizes barcodes and abarcode reader as apparatus to input and read machine readableinformation, those skilled in the art will appreciate that otherapparatus for reading or inputting information may be utilized. Machinereadable indicia or identifying information may be provided by atransmitter, radio frequency identification (RFID) tag, or transponderand read by a radio frequency receiver or transceiver. The system mayalso utilize digital photography or imaging and scanning technology.Human biometric data, including retina patterns, voice, skin,fingerprints, and the like may also be recognized by an appropriatescanner or receiver. Moreover, POC client 3126 may comprise anidentification receiver 32 adapted to recognize such indicia may beprovided in the MMS.

In certain aspects, the IV fluids and/or medications 3100 in container3102 may be provided with new or supplemental labels with a uniqueinfusion order identifying barcode by a pharmacist according to certainhospital practices. Specifically, drug container specific identificationinformation, such as barcoded information on the container 3102 mayinclude patient identification information, including a patient name,patient number, medical record number for which the medication has beenprescribed, medication identification information such as a medicationname or solution within the IV container 3102, universal identificationinformation which may be created or assigned at the hospital, medicaldevice delivery information, such as the operating parameters to use inprogramming an infusion pump to deliver fluids and/or medication 3100 tothe patient 3104, and/or medication order information, such as one ormore of above information items and/or other medication orderinformation specific to a particular patient 3104, and which may be apart of a medication order for a particular patient. The IV fluidsand/or medications 3100 in barcode-identified containers 3102 may besupplied to hospitals by various vendors, with preexisting uniquebarcode identifiers which include medication information and otherinformation, such as a National Disease Center (NDC) code, expirationinformation, drug interaction information, and the like.

In some aspects of the disclosure, the universal identificationinformation on the container 3102 may be a unique medication orderidentifier that, by itself, identifies the order associated with thecontainer. In other aspects, the identification information on thecontainer 3102 may be a composite patient/order code that contains botha patient ID (such as a medical record number) and an order ID uniqueonly within the context of the patient. In certain aspects, theidentification information on the container 3102 may comprise amedication ID. Within a particular hospital, all medication prepared orpackaged for patients by the pharmacy may contain either a compositepatient/order ID or a universally unique order ID, but generally notwithin the same hospital. The medication ID alone option may be usedonly for medication that are pulled by a nurse directly from floor stockat the point of care.

The system identified in FIG. 1 may comprise a drug library editor (DLE)or DLE computer 3106, such as a notebook, desktop or server computer.The DLE computer 3106 may comprise DLE software that runs on the DLEterminal, computer or workstation 3106, shown as DLE Client in FIG. 1 .As described above, a medication management unit (MMU) or computer 3108,such as a server, may have MMU software that is installed and runs onthe MMU server 3108. The drug library and other databases may be storedon the MMU server 3108, a separate server, and/or in remote locations.

Hospital information systems (HIS) 3110 may include one or morecomputers connected by cabling, interfaces and/or Ethernet connections.Alternatively wireless connections and communications may be used inwhole or in part. Servers provide processing capability and memory forstorage of data and various application programs or modules, includingbut not limited to a module for admissions-discharge-and-transfer (ADT)3112, a computerized physician order entry (CPOE) module 3114, and apharmacy information system (PIS) module 3116. Hospital personnel, suchas admission clerks 3118, physicians 3120, and pharmacists 3122,respectively, may be authorized to access these modules through clientworkstations connected to the servers in order to enter data, accessinformation, run reports, and complete other tasks.

In the embodiment shown in FIG. 1 , the HIS 3110 may also include apoint of care (POC) system 3125 including a server or POC computer 3124(sometimes referred to as a barcode point of care server or computer),or the POC computer 3124 may be separate from the HIS 3110. The POCcomputer 3124 may act as a part of a point of care (POC) system 3125(sometimes referred to as the barcode point of care system or BPOC) andmay be able to wirelessly communicate through a plurality of wirelesscommunication nodes located throughout the hospital, utilizing awireless communications protocol, such as IEEE 801.11, IEEE 802.11, orBluetooth. The POC computer 3124 may communicate wirelessly with aportable thick client POC or input device 3126 carried by a caregiver.The POC client device 3126 may be a personal digital assistant (PDA)that comprises significant memory, display and processing capabilities.The POC client device may execute a variety of programs stored in itsmemory in some degree independently of the POC computer 3124.

In one embodiment of FIG. 1 , the MMU server 3108 may be hard-wired tothe DLE client desktop computer/workstation 3106 and to a MMU clientcomputer/workstation 3128. Alternatively, the MMU and DLE clientfunctions may be combined onto a single client computer/workstation ormay reside together with the MMU server 3108 on a single combinedMMU/DLE server. The MMU server 3108 may reside in a location remote fromthe patient's room or treatment area. For instance, the MMU server 3108may reside in a secure, climate controlled information technology roomwith other hospital servers and computer equipment and its clientterminals may be located in the pharmacy, biomedical engineering area,nurse station, or ward monitoring area. One MMU server 3108 may monitor,coordinate and communicate with many infusion pumps 3130. For example,in one embodiment, the MMU software running on the MMU server 3108 maysupport up to one thousand infusion pumps concurrently.

In embodiment of FIG. 1 , the client PDA 3126 in the POC computer system3125 may communicate through the POC server 3124 with the MMU server3108. The MMU server 3108 may interface or communicate wirelessly withthe infusion pump 3130 through the same wireless nodes 84 utilized bythe POC system 3125 and a connectivity engine and antenna on or in theinfusion pump 3130. Communication between the infusion pump 3130 and thePOC client 3126 may take place through the MMU server 3108 and POCserver 3124. The MMU computer 3108 may store in an associated memoryboth the logical ID and the network ID or Internet Protocol (IP) addressof the infusion pump(s) 3130, such that only the MMU computer 3108 maycommunicate in a direct wireless manner with the infusion pump 3130.Alternatively the MMU 3108 may provide the IP address and otherinformation about the pump 3130 to the POC system 3125 to facilitatedirect communication between the POC system 3125 and the pump 3130.

Upon admission to the hospital, the admission clerk 3118 or similarpersonnel may enter demographic information about each patient 3104 intoan associated memory of the ADT computer or module 3112 of an HISdatabase stored in an associated memory of the HIS system 3110. Eachpatient 3104 may be issued a patient identification wristband, braceletor tag 112 (or other patient identification device) that may include anidentifier 3103, such as a barcode or RFID tag for example, representinga unique set of characters, typically a patient ID or medical recordnumber, identifying the patient, sometimes referred to as patientspecific identification information. The wristband, bracelet or tag 112may also include other information, in machine readable orhuman-readable form, such as the name of the patient's doctor, bloodtype, allergies, and the like as part of the patient specificidentification information.

The patient's doctor 3120 may prescribe medical treatment by entering anorder into the CPOE computer terminal or module 3120 within the HISsystem 3110. The order, as prescribed, may specify a start time, stoptime, a range of allowable doses, physiological targets, route, and siteof administration. In the case of an order for infusion of fluids ormedication, the order may be written in various formats, but typicallyincludes the patient's name, patient ID number, a unique medicationorder or prescription number, a medication name, medicationconcentration, a dose or dosage, frequency, and a time of desireddelivery. This information may be entered into the memory of the CPOEcomputer 3124, and may be stored in a memory associated with at leastthe POC server or computer 3124.

The medication order may also be delivered electronically to the PIScomputer 3116 in the pharmacy and may be stored in an associated memory.The pharmacist 3122 may screen the prescribed order, translate it intoan order for dispensing medication, and prepare the medication or fluidswith the proper additives and/or necessary diluents. The pharmacist 3122may prepare and affix a label 102 with drug container specificidentifying information 3101 to the medication or drug container 3102.In one embodiment, the label only includes in machine-readable (barcode,RFID, etc.) form a unique sequentially assigned “dispense ID number”that may be tied to or associated with the particular patient ID numberand medication order number in the HIS 3110, PIS 3116 and/or POCcomputer 3125. In another embodiment, the label may include in machinereadable form a composite identifier that includes an order ID and apatient ID, which may be a medical record number. In another embodiment,the label does not include a patient ID at all in barcode or machinereadable format but includes in machine readable form only a medicationID. Another embodiment may be useful for “floor stock” items that arecommonly stocked in operating rooms, emergency rooms, or on a ward foradministration on short notice with ad hoc or post hoc orders. Inanother embodiment, the label may include in machine readable and/orhuman-readable form medical device specific delivery informationincluding but not limited to the dispense ID number, patient ID, drugname, drug concentration, container volume, volume-to-be-infused(“VTBI”), rate or duration, and the like. Only two of the threevariables VTBI, rate and duration may be required to be defined as thethird may be calculated when the other two are known. The labeledmedication may be delivered to a secure, designated staging location ormobile drug cart on the ward or floor near the patient's room ortreatment area. The medication order pending dispensing oradministration may be posted to a task list in the HIS system 3110 andPOC system 3125 and stored in an associated memory.

The caregiver 3132 (e.g., a nurse) may use the identification receiver32 associated with the POC client 3126 to scan the caregiver specificidentification information 3133 or barcode on his/her caregiveridentification badge 116 (or other caregiver identification device) andenter a password, which logs the caregiver into the system andauthorizes the caregiver to access a nurse's task list from the POCsystem 3125 through the POC client 3126. The information within thenurse's badge 116 is sometimes referred to as the caregiver specificidentification information herein. The caregiver 3132 may view from thetask list that IV drugs are to be administered to certain patients 3104in certain rooms. The caregiver 3132 obtains the necessary supplies,including medications, from the pharmacy and/or a staging area in thevicinity of the patient's room.

The caregiver 3132 may take the supplies to a patient's bedside, turn onthe infusion pump 3130, verify that the network connection icon on thepump 3130 indicates a network connection (for example, a wirelessconnection such as Wi-Fi or the like) is present, select the appropriateclinical care area (CCA) on the pump, and mount the IV bag, container,or vial 3102 and any associated tube set as required in positionrelative to the patient 3104 and infusion pump 3130 for infusion.Another connection icon on the pump 3130 or pump user interface screencan indicate that a wired or wireless connection to the MMU server 3108is present. Using the identification receiver/reader integral to the POCclient PDA 3126, the caregiver 3132 may scan the barcode on thepatient's identification wristband, bracelet or tag 112 or other patientidentification device. A task list associated with that particularpatient may appear on the PDA 3126 screen. The task list, which may alsoinclude orders to give other forms of treatment or medication by otherroutes (oral, topical, etc.), may be obtained from the HIS via the POCserver 3124 and communicated wirelessly to the POC client PDA 3126. Inone embodiment, the list is generated by matching the scanned patient IDwith the patient ID for orders in memory within the POC server 3124. Inanother embodiment, as will be described below, the order informationmay be obtained by scanning the drug container specific identificationinformation for associated orders in memory within the POC server 3124,through the following step(s).

The caregiver 3132 may scan the medication barcode label 102 containingmedication container specific identification information 3101 on themedication container 3102 with the PDA 3126. The PDA 3126 may highlightthe IV administration task on the task list and send the scannedmedication container specific identification information, such asdispense ID information, from the medication container 3102, to the POCserver 3124, which uses the medication container specific identificationinformation, such as the dispense ID, to pull together the rest of theorder details and send them back to the PDA 3126. The PDA 3126 may thendisplay an IV Documentation Form on its screen. One side of the IVDocumentation Form screen may show the order details as “ordered” andthe other side may be reserved for a status report from the infusionpump 3130. The status report from the infusion pump 3130 may betransmitted to the PDA 3126 through the POC server 3124 and MMU server3108, as will be described below. The lower portion of the IVDocumentation Form screen may provide the caregiver 3132 withinstructions (like to scan the infusion pump 3130 barcode) or identifywhether the pump is running or stopped.

The caregiver 3132 may then scan the barcode label 92 associated withthe infusion pump 3130 (or pump channel if the pump is a multi-channelpump). The barcode label 92 may contain medical device specificidentification information 3131, such as the logical name and/or logicaladdress of the device or channel. The POC system 3125 then automaticallybundles the information into a program pump request containing the“order details” and in one embodiment, without further interaction withthe caregiver 3132, transmits this information to the MMU server 3108.

The program pump request may include at least some of the followinginformation (in HIS/POC system format): a Transaction ID, which mayinclude a Logical Pump ID, a Pump Compartment, a Pump Channel ID, aReference Device Address, a Caregiver ID, a Caregiver Name, aPatient/Person ID (HIS identifier), a Patient Name, a Patient Birth Date& Time, a Patient Gender, a Patient Weight, a Patient Height, and anEncounter ID which may include a Room, a Bed, and a Building (includingClinical Care Area or CCA). The program pump request may also includeOrder Information or “order details”, including an Order ID, a StartDate/Time, a Stop Date/Time, a Route of Administration, a Rate, aDuration of Infusion (Infuse Over), a Total Volume to be Infused (VTBI),an Ad Hoc Order Indicator, and Ingredients including HIS Drug Name orHIS Generic Drug Name, HIS Drug Identifier or HIS Generic Drug ID, RxType (Additive or Base), Strength w/units, and Volume w/units. Theprogram pump request may further include Patient Controlled Analgesia(PCA) Orders Only information, such a PCA Mode-PCA only, Continuousonly, or PCA and Continuous, a Lockout Interval (in minutes), a PCAContinuous Rate, a PCA Dose, a Loading Dose, a Dose Limit, a Dose LimitTime w/units, a Total Volume in vial or syringe, and Order Comments.

The MMU 3108 may map or convert the wide range of expressions of unitsallowed by the HIS system 3110 or POC system 3125 for PDA 3126 requestsinto the much more limited set of units allowed in the MMU 3108 andinfusion pump 3130. For example, the PDA 3126 request may express “g,gm, gram, or grams” whereas the MMU 3108 and/or infusion pump 3130 mayaccept “grams” only. Infusion pump 3130 delivery parameters or infusionpump 3130 settings are mapped or converted from corresponding orderinformation or “order details” of the program pump request.

The MMU 3108 may store in an associated memory a mapping or translationtable that keep track of the logical ID, serial number or otheridentifier of an infusion pump 3130 and the corresponding currentnetwork (static or dynamic) address (Internet Protocol (IP) address) orID of the infusion pump 3130 on the network, which in this example is awireless network. The MMU 3108 may be able to translate or associate agiven identifier of the infusion pump 3130 with its network address inthe translation table and provide the network IP address to therequesting POC system 3125 or device. The MMU 3108 may also store in anassociated memory and/or may look up the drug library applicable to thescanned infusion pump 3130 and may also convert the Drug ID and Strengthfrom the pump program request into an index number of the medication atthe desired strength or concentration from the drug library. Theduration of the infusion may come from the POC system 3125 in hours andminutes and may be converted to just minutes for the infuser torecognize it. Volume or VTBI may be rounded to provide a value-specificand infuser-specific number of digits to the right of the decimal point.Units (of drug) may be converted to million units where appropriate.Patient weight may be converted and either rounded according toinfuser-specific rules or not sent to the infuser.

Once the MMU 3108 transforms the information from the program pumprequest into infusion pump settings or delivery parameters and otherinformation in a format acceptable to the infusion pump 3130, the MMU3108 may wirelessly download a command message to the infusion pump3130. If the infusion pump 3130 is not already equipped with the latestappropriate version of the hospital-established drug library, the MMU3108 may also automatically download a drug library to the infusion pump3130. The hospital-established drug library may be maintained in aseparate process undertaken by the biomedical engineer or pharmacist3122 to place limits on the programming of the infusion pump 3130, aswell as other infusion pump operating parameters such as default alarmsettings for air in the line, occlusion pressure, and the like. The druglibrary may set up acceptable ranges or hard and/or soft limits forvarious drug delivery parameters in the infusion pump 3130.

The MMU 3108 may also download to the infusion pump new versions,patches, or software updates of the infusion pump's internal operatingsystem software. The infusion settings or delivery parameters and otherinformation from the MMU 3108 may be entered into the memory of theinfusion pump 3130 and the infusion pump 3130 settings may automaticallypopulate the programming screen(s) of the infuser, just as if thecaregiver 3132 had entered the information and settings manually. Theinfusion pump 3130 screen may populate with the name of the drug anddrug concentration based on the drug library index number, patientweight (if applicable), rate, VTBI, and duration (only two of the lastthree variable are sent by the MMU 3108 because the pump 3130 maycalculate the third from the other two). A return message ofconfirmation signal may be sent to the MMU 3108 by the infusion pump3130 to indicate that the command message has been received. At thispoint, if necessary, the caregiver 3104 may manually enter anyadditional infusion settings or optional information that was notincluded in the command message.

The infusion pump 3130 may then prompt the caregiver 3132 to start theinfusion pump 3130 by pressing the start button. When the caregiver 3132presses the start button, a confirmation screen with the infusionsettings programmed may be presented for confirmation and anauto-program acknowledgment message can be sent to the MMU server 3108to forward without request (i.e., pushed in a near real-time manner) orprovide to the POC system 3125 when requested or polled. When thecaregiver 3132 presses the button to confirm, the infusion pump 3130 maybegin delivering fluid according to the programmed settings. Theinfusion pump 3130 may send a status message to the MMU 3108 indicatingthat the infusion pump 3130 was successfully auto-programmed, confirmedand started by the caregiver 3132, and is now delivering fluid. Thisinformation may also be displayed at the infusion pump. The MMU 3108 maycontinue to receive logs and status messages wirelessly from theinfusion pump 3130 periodically as the infusion progresses or whenalarms occur.

The MMU 3108 may report a portion of the initial status message to thePDA 3126 through the POC server 3124 (in MMU format) to indicate thatthe infusion pump 3130 has been auto-programmed and the caregiver 3132has confirmed the settings. The MMU 3108 may communicate to the POCsystem 3125 and/or at the infusion pump 3130 the actual Rate, VTBI andDuration. A notation at the bottom of the PDA screen and/or the infusionpump may indicate that the infusion pump 3130 is running. The infusionpump 3130 may compare and give a visual, audio or other type ofaffirmative signal if the pump information matches or acceptablycorresponds with the ordered information. An initial determination ofwhether the pump information matches the order may be done in the MMU3108 and communicated to the PDA 3126 through the POC server 3124.Alternatively, the POC server 3124 or the infusion pump 3130 may makethe necessary comparisons. If the pump information does not match theorder, the infusion pump 3130 at the display 88 may output a visual,audio or other type of negative signal, which may include an errormessage.

At least one embodiment of the invention includes a first computer, suchas a medication management unit (MMU) 3108, including a computer networkinterface and the at least one infusion pump 3130. In one or moreembodiments, the first computer communicates with the at least oneinfusion pump 3130 via the computer network interface.

By way of one or more embodiments, the first computer receives at leastone infusion auto-program from a remote source. In at least oneembodiment, the remote source may include a hospital information system,pharmacy information system or medication administration system and thefirst computer may include the medication management unit (MMU) 3108,such as a server equipped with Hospira MedNet™ software. In one or moreembodiments, the at least one infusion auto-program may include one ormore of IV drug container information, infusion pump information, andinfusion program settings.

In at least one embodiment, the first computer transmits the at leastone infusion auto-program to the at least one infusion pump 3130. In oneor more embodiments, the first computer may queue the at least oneinfusion auto-program when the first computer is unable to transmit theat least one infusion auto-program to the at least one infusion pump3130. In at least one embodiment, the first computer sends the at leastone stale auto-program to the at least one infusion pump 3130 when theat least one infusion pump 3130 communicates with the first computer.

According to one or more embodiments of the invention, the at least oneinfusion pump 3130 may receive at least one manual infusion program fromthe at least one caregiver 3132. In one or more embodiments, the atleast one manual infusion program may include one or more of a completedmanual infusion program or a running manual infusion program.

The caregiver 3132 may be prompted to review and press a save button onthe infusion pump 3130 if the order has been begun as desired or anyvariations are acceptable. The MMU 3108 may receive status, event,differences and variation information from the infusion pump 3130 andpass such information to the POC system 3125. In a separate subsequentstep, the nurse may electronically sign the record and presses a sendbutton on the POC client PDA 3126 to send the information to thepatient's electronic medication record (EMR) or medicationadministration record (MAR).

Referring now to FIGS. 2 and 3 , flowcharts further illustrate a systemand method for notifying a caregiver (e.g., caregiver 3132, such as anurse) at an infusion pump 3130 of the status of administration of fluidand/or medication 3100 to a patient 3104 according to aspects of thedisclosure. In one embodiment, the POC system 3125 sends a program pumpmessage containing infusion pump settings to the MMU computer 3108,which looks up the targeted infusion pump 3130 according to itsidentifier and relays the infusion pump settings to the pump 3130. Inanother embodiment, when the POC system 3125 is auto-programming theinfusion pump 3130, the POC system 3125, including the POC computer 3124and/or the POC client 3126 may request the MMU 3108 for permission toprogram the infusion pump 3130. The MMU computer 3108 may grant thispermission and then the POC system 3125 may communicate directly withthe infusion pump 3130, without intervention by the MMU computer 3108.The MMU computer 3108 may continually receive asynchronous orsynchronous near real-time status messages and event logs from theinfusion pump 3130 and store this information in an associated memoryfor purposes of at least displaying infusion pump 3130 status andgenerating reports.

In certain aspects of the disclosure, prior to beginning the workflowillustrated in FIGS. 2 and 3 , a caregiver 3132 may first be required touse POC system 3125 to scan an identifier of the caregiver's ID badge116. The POC system 3125 may then determine if the caregiver 3132 is avalid POC system 3125 user. The POC system 3125 may also require thecaregiver 3132 to enter a password, user name, and/or other information.

As shown in FIGS. 2 and 3 , the caregiver 3132 may initiate the workflowfor automatically programming the infusion pump 3130 by scanning thepatient's wristband (step 201), scanning the IV bag (step 203), andscanning the infusion pump (step 205). At step 201, the caregiver 3132may use a scanner, such as identification receiver 32 at POC client3126, to scan the identifier on the patient's wristband, bracelet, ortag 112. The patient ID, which may be a medical record number, anaccount number or some other identifier that the care facility uses topositively identify the patient, may be retained in a memory in the POCclient 3126.

At step 203, the caregiver 3132 may use the POC client 3126 to scan theidentifier 3101 on the identification label 102 on the IV bag 3102. Thecontainer ID 3101 may comprise machine-readable indicia such as a barcode, RFID tag, or the like. The container ID 3101 may be a universallyunique order ID so that the HIS 3110 or POC system 3125 may retrieveinformation about the association medication order without having toscan the patient ID on the patient wristband, bracelet, or tag 112 (orother patient identification device) or rely on such patient IDinformation for comparison purposes. Alternatively, the container ID maybe a composite ID that includes patient ID or some portion thereof andan order ID related to that particular patient. Alternatively, thecontainer ID may be an absolute or unique pharmacy order identifier thatmay be generated by the order entry or pharmacy information systems.Alternatively, for commonly used containers that are stocked on the wardor patient care floor, like dextrose, saline or other solutions, thecontainer ID may be a medication ID that includes onlymedication-specific information, including but not limited to medicationname, concentration (if applicable) and volume.

At step 205, the caregiver 3132 may use the POC client 3126 to scan thebarcode label 92 or RFID tag on the infusion pump 3130 or a channel ofthe pump to obtain medical device specific identification information3131 on the identifier. Thus, the POC client 3126 may receive or capturethe pump ID or identifier information. Steps 201, 203, and 205 may beperformed in any order. For instance, the caregiver 3132 may performstep 203 first, followed by steps 201 and 205, or may perform step 205first, followed by steps 203 and 201, and the like.

As shown in FIGS. 2 and 3 , the information scanned by the caregiver3132 at steps 201, 203, and 205 may be transmitted to the patient'selectronic medical records (EMR) and/or the barcode medicationadministration (BCMA). In certain aspects, the caregiver 3132, afterperforming the scans with the POC client 3126, may select a button (suchas a “start” or “done” button) on the POC client 3126. Selection of thebutton may cause the POC client 3126 to transmit the scanned informationto the EMR/BCMA. The BCMA may comprise, for example, POC system 3125.

Based on the received scanned information, the EMR/BCMA within the HIS3110 may look up patient demographic information it received from theAdmission, Discharge and Transfer (ADT) system 3112 and an infusionorder for the patient or medication it received from the PharmacyInformation System (PIS) 3116. Software in POC system 3125 may thenperform a variety of safety checks, comparisons or matching functions toensure that the right drug is administered to the right patient, at theright rate, in the right dose, at the right time, via the right route,and by an authorized or right caregiver, etc. as is conventional in theBCMA art. The BCMA/POC system 3125 then transmits an auto-programmingmessage containing infusion pump settings to the MMU 3108.

At step 209, based upon the pump identification information contained inthe auto-programming message, the MMU 3108 may then look up the infusionpump network location to determine the pump that is targeted to receivethe infusion pump settings contained in the auto-programming message.

At step 211, the MMU 3108 may send the infusion pump settings to theinfusion pump 3130 using the pump's IP address. At step 213, theinfusion pump 3130 may receive the infusion pump setting and then verifythe infusion program settings against the installed drug library. Inother words, the infusion pump 3130 may ensure that the received programsettings for the patient 3104 are consistent with the informationprovided in the drug library. Steps 215, 217, and 219 shown in FIG. 2illustrate exemplary steps that may be performed after the infusion pumphas determined that the program settings are consistent with thepermissible settings specified in the drug library of the pump 3130. Asdiscussed further below, steps 315, 317, and 319 shown in FIG. 3illustrate exemplary steps that may be performed after the infusion pumphas determined that the program settings are inconsistent with thepermissible settings specified in the drug library of the pump 3130.

As shown in FIG. 2 , at step 215, after the infusion pump 3130 hasverified that the program settings are consistent with the drug library,the infusion pump may populate the program settings, for example atdisplay screen 88. The infusion pump 3130 may display one or moreprogram settings at display screen 88, such as drug name, drugconcentration, container volume, VTBI, rate or duration, and the like.The infusion pump 3130 may also display a request for a nurse to confirmthe displayed program settings.

At step 217, the caregiver 3132 may review and verify that the displayedinfusion program settings were correctly populated. The caregiver 3132,in some aspects, may be required to select a button at the infusion pump3130 in order to indicate confirmation that the infusion programsettings were correctly populated. In response, the infusion pump 3130may display a start button on screen 88 that enables the caregiver 3132to start the infusion in accordance with the final confirmed programmedpump settings. The caregiver 3132 may select the start button to startthe infusion program at step 219.

Referring now to FIG. 3 , workflow steps illustrate an exemplary processin which the infusion pump settings are inconsistent with the settingsstored in the drug library. The process illustrated in FIG. 3 comprisesthe same steps 201, 203, 205, 207, 209, 211, and 213 as FIG. 2 .However, the auto-programming workflow illustrated in FIG. 3 comprisesexemplary steps 315, 317, 319, 321, 323 and 325 not performed at FIG. 2, and which may be performed after infusion pump 3130 determines thatthe infusion program settings are inconsistent with the drug library atstep 213 or in the case of steps 321, 323 and 325, if the manual programis acceptable, yet perhaps not an exact match for a stale auto-programthat arrives after or during a manual infusion for example. Embodimentsgenerally analyze and save these events wherein the caregiver may alsobe notified that an auto-program has arrived, but that the caregiver hassuccessfully manually programmed the infusion pump, whether exactly oracceptably when compared to the auto-program.

At step 315, infusion pump 3130 may display an error message. The errormessage may be reported to the MMU 3108 at step 315 a. The error messagemay be relayed and reported to the EMR/POC system 3125 via the MMUserver 3108 at step 315 b. Alternative, the error message can bereported directly from the pump 3130 to the EMR/POC system 3125 throughany wired or wireless networks available in the hospital. Mostimportantly, the error message may be displayed at or on the displayscreen 88 of infusion pump 3130. Thus, even if the caregiver has limitedor no access to the POC client or other computer systems within thehospital at the time, they will be advised of auto-programming errors atthe pump 3130. As will be discussed in greater detail below, the errormessage may notify the caregiver 3132 of the rejection of theauto-programming request. The error message may comprise an error codeand a brief description of the error cause. The error message mayfurther comprise suggested actions for the caregiver 3132 to perform inresponse to the error message. For example, if the keypad is locked, theinfusion pump 3130 may output an error message KLO00017 stating “Theauto-program is not valid because the keypad is locked.” The infusionpump 3130 may also display, on the same screen, a suggested orrecommended action, e.g., “Unlock the keypad”. A table of errors,including exemplary code numbers, descriptions and recommended actionsare included below in Table 1.

TABLE 1 Messages and Suggested Actions Relating to Auto-Programs ErrorCode Message Action EPC00001 Order rejected. Physician's Recheck theorder with order for an automatically pharmacy or physician. programmedtherapy exceeds the capabilities of the pump. HLV00002 Order rejected.Physician's Recheck the order with order for an automatically pharmacyor physician. programmed therapy exceeds a hospital-defined drug libraryhard limit. NTA00003 The auto-program received Press [OK] now, or waitfor contains duration information, this screen to automatically and youcannot titrate the dismiss. duration of a delivery with this dosingunit(s). MRI00004 The auto-program received Press [OK] now, or wait fordid not contain all required this screen to automatically information.dismiss. SLV00005 The auto-program received Press [OK] now, or wait forcontains a value that exceeds a this screen to automatically systemlimit. Or the values dismiss. cause a calculated parameter to exceed asystem limit. MCD00006 The auto-program received Press [OK] now, or waitfor contained a medication which this screen to automatically isdifferent from what is dismiss. delivering on the programmed line.UPD00007 The auto-program is for a line Resubmit the auto-program. thatcontains unconfirmed All unconfirmed data will be programming data.cleared. LIS00008 The auto-program is for a line Clear this line andresubmit which is in Standby. the auto-program. LDS00009 Theauto-program is for a line Clear this line and resubmit which is inDelay Start. the auto-program. ACP00010 The auto-program is for a lineClear alarm condition and that has an active alarm that resubmit theauto-program. stops or prevents delivery, thus the auto-program is notvalid in this alarm condition. COV00011 The auto-program is not validPress [OK] now, or wait for due to concurrency violation. this screen toautomatically Delivery A + B greater than dismiss. 500 mL/hr or lessthan 0.5 mL/hr for each line. NIB00012 The auto-program is not validPress [OK] now, or wait for for line B. The medication this screen toautomatically delivering on line A cannot be dismiss. interrupted.NMW00013 The auto-program is not valid Press [OK] now, or wait forbecause the weight in the this screen to automatically auto-program doesnot match dismiss. the weight on the program delivering on the otherline. NMH00014 The auto-program is not valid Press [OK] now, or wait forbecause the height in the auto- this screen to automatically programdoes not match the dismiss. height on the program delivering on theother line. NMB00027 The auto-program is not valid Press [OK] now, orwait for because the BSA in the auto- this screen to automaticallyprogram does not match the dismiss. BSA on the program delivering on theother line. NCS00015 The auto-program is not valid Select a CCA andresubmit the because a CCA has not been auto-program. selected on theinfuser. NVD00018 The auto-program is not valid Press [OK] now, or waitfor because the received this screen to automatically parameters willnot result in a dismiss. valid dose. NDT00016 The auto-program is notvalid Press [OK] now, or wait for because the drug in the this screen toautomatically confirmed program was a “No dismiss. Drug Selected”auto-program and titration is not allowed. ZVV00019 The auto-program isnot valid Press [OK] now, or wait for because the Rate cannot be thisscreen to automatically titrated when VTBI is 0. dismiss. NCP00020 Theauto-program is not valid Press [OK] now, or wait for because it is atitration for a this screen to automatically line that has no confirmeddismiss. program. KLO00017 The auto-program is not valid Unlock thekeypad. because the keypad is locked. MLV00021 The auto-program is notvalid Press [OK] now, or wait for for a line with a Multistep or thisscreen to automatically Loading dose program. dismiss. NIA00022 Theauto-program is not valid Press [OK] now, or wait for for line A. Themedication in this screen to automatically the auto-program is notdismiss. interruptible and Line B is delivering a Piggyback infusion.ICD00023 The auto-program for this Press [OK] now, or wait for infuserwas rejected by this screen to automatically Hospira MedNet due todismiss. incomplete or corrupt data. DLI00024 The auto-program for thisPress [OK] now, or wait for infuser was rejected by this screen toautomatically Hospira MedNet due to drug dismiss. libraryincompatibility. PPL00025 The auto-program is rejected Press [Clear] andresubmit the because of a partially auto-program. All programmed line.unconfirmed data will be cleared. ITP0026 The auto-program is rejectedPress [OK] now, or wait for because auto-programming is this screen toautomatically performed on a line in the dismiss. PENDING or PUMPINGstate and the Post Infusion Rate (KVO or RATE) is interpreted as notbeing a titration. A pump with an installed cassette was started. TheCCA was selected. Line A was programmed and delivery was started. Abarcode was scanned and an order on line A was placed. The auto- programfor line A was sent to the infuser. The infuser determines that theauto-program is a new delivery based on titration rules and rejects theauto- program.

At step 317, the caregiver 3132 may review and respond to the errormessage displayed at the infusion pump 3130. The caregiver 3132 mayprovide a response that comprises at least one of a modification to theauto-programming request, performing the actions suggested at the pump3130, and/or rejecting or clearing the error message and suggestedaction. Based on the response to the error message received at step 317,pump 3130 may perform an operation at step 319. For example, afterdisplaying the error message provided above and suggested action “Unlockthe keypad”, infusion pump 3130 may receive a response from thecaregiver 3132 that the keypad has been unlocked. The caregiver's actionof unlocking the keypad may itself serve as the response to the errormessage at step 317. Thereafter, the operation performed at step 319 maycomprise the infusion pump starting the infusion program similar to orthe same as step 219 illustrated in FIG. 2 . Thus, if the caregiver 3132responds to the error message at step 317 by performing the suggestedaction, the infusion pump 3130 may, at step 319, automatically start therequested infusion auto-program. The caregiver 3132 may respond to theerror message by adjusting program settings such as dose, rate, VTBI,duration, and the like on the infusion pump 3130.

In some aspects, the caregiver 3132 may reject or override the errormessage displayed at step 315. The caregiver 3132 may override the errormessage at step 317 in cases of soft limit violations. Some limitviolations may require entry of a special override code or input of acode from a second caregiver or supervisory personnel. In another aspectof the invention, the infusion pump 3130 may display an error messagethat a pump channel is “Already in Use”. The caregiver 3132 mayinvestigate and determine that the pump is not in use. The caregiver3132 may send a response rejecting the error message and indicating thatthe pump channel is not currently in use. The pump 3130 may then returnto step 213 to verify infusion program settings against the installeddrug library or may automatically start the infusion program at step219.

In certain aspects, the caregiver 3132 may not input a response intoinfusion pump 3130 within a predetermined time. The lack of a responsewithin this predetermined time may itself server as a response to errormessage 317. Specifically, the infusion pump 3130 may be configured (forexample, by the manufacturer or the hospital via the user customizeddrug library configuration settings downloaded to the pump by the MMU)to timeout after a predetermined time. The predetermined time may beabout 15 seconds, 30 seconds, 35 seconds or any other amount of time. Ifthe infusion pump 3130 does not receive a response within the timeoutperiod (or predetermined time), the infusion pump 3130 may reject theauto-program and display a previous or home screen at display screen 88.In this case, the operation performed at step 319 may comprise clearingthe error message and displaying a previous or home screen at the pump3130.

In one or more embodiments, the at least one infusion pump 3130 savesand executes the at least one manual infusion program received from theat least one caregiver 3132. At step 321, in at least one embodiment,the at least one infusion pump 3130 compares the at least one staleauto-program to the at least one manual infusion program that has beencompleted or is running.

In at least one embodiment of the invention, the at least one manualinfusion program may be entered at the infusion pump and/or accessed asprovided in a library stored at the at least one infusion pump 3130. Inone or more embodiments, the comparison may be based on an approximatetime of infusion administration and parameter matching logic includinginfusion administration parameters and infusion pump operatingparameters, for example volume to be infused, rate, or any othercharacteristic available in the system.

By way of at least one embodiment, the at least one infusion pumpcompares the infusion pump operating parameters and the infusionadministration parameters to identify potential matches between the atleast one stale auto-program and the at least one manual infusionprogram. In one or more embodiments, the at least one infusion pump 3130may evaluate the potential matches using one or more configurable rulesand determines if the potential matches are within a predefinedtolerance. In at least one embodiment, the at least one infusion pump3130 may continue to execute the at least one manual infusion program onthe at least one infusion pump 3130 if the potential matches are withinthe predefined tolerance. Any type of logic including neural networks,rule based, threshold or range based may be utilized to determinewhether an acceptable manual program has executed or is executing whencompared with the stale auto-program.

At step 323, in one or more embodiments, the at least one infusion pump3130 saves differences in the at least one manual infusion program andthe at least one stale auto-program in the remote server or MMU 3108 forlater analysis and/or data mining. This may allow the management systemto determine which caregivers are accurate or even may be utilized todetermine whether better outcomes of care result from a slightlydifferent, yet acceptable manual program when compared to theauto-program as well as determine whether cost saving may be made whilemaintaining a given level of service, for example with shorter patientstays or less drug volume used overall. Any other large data analysis isin keeping with the invention when comparing manual programs and staleauto-programs and any parameters associated with the patient, drug,volume to be infused, rate, or any patient characteristics such as ageor time of stay or any other parameter.

In at least one embodiment, the at least one infusion pump 3130 remotelysaves a first event alert indicating the at least one manual infusionprogram as an acceptable potential match of the potential matches, andremotely saves a second event alert indicating the at least oneauto-program as an un-executed program because the at least one manualinfusion program is an acceptable potential match.

At step 325, in one or more embodiments, the at least one infusion pump3130 may optionally notify the at least one caregiver 3132 of theacceptable at least one manual infusion program using the first eventalert, and optionally notify the at least one caregiver 3132 of the atleast one auto-program as an un-executed program using the second eventalert.

According to at least one embodiment of the invention, the at least oneinfusion pump 3130 may include a graphical user interface comprisingkeys and a display screen 88 or an input/output touch screen 88 on theat least one infusion pump, such that the at least one caregiver 3132may input the at least one manual infusion program via the graphicaluser interface.

In one or more embodiments, the at least one infusion pump 3130 may saveidentification data of the at least caregiver 3132. In at least oneembodiment of the invention, the at least one infusion pump 3130compares the at least one manual infusion program from the at least onecaregiver 3132 to the at least one stale auto-program to determine ascoring of accuracy. In at least one embodiment, the scoring of accuracymay include an acceptability level of the at least one manual infusionprogram from the at least one caregiver.

By way of one or more embodiments of the invention, the at least oneinfusion pump 3130 may generate at least one report from the comparisonof the at least one manual infusion program to the at least one staleauto-program. In at least one embodiment, the report generated by the atleast one infusion pump 3130 may include one or more of a timedifferential between completion time of the at least one manual infusionprogram and completion time of the at least one stale auto-program, ascoring of accuracy including an acceptability level between infusionadministration parameters of the at least one manual infusion programand the at least one stale auto-program, and a rating of the at leastone caregiver 3132.

In at least one embodiment of the invention, the accuracy/effectivenesshistory or rating of the at least one caregiver 3132 may determine ifthe at least one manual infusion program received from said at least onecaregiver 3132 is acceptable and/or more accurate or effective than theat least one auto-program. The at least one stale auto-program isaggregated and compared using matching logic (either statically residingon the pump or dynamically provided with the auto-program) to the atleast one manual infusion program received from the at least onecaregiver 3132 at the at least one infusion pump 3130. This comparisongenerates an auto-program compliance information/rating or contributesto an overall auto-program compliance information/rating for the atleast one caregiver 3132. The at least one infusion pump 3130 wouldsubsequently display the at least one caregiver 3132 complianceinformation (rating) for the at least one caregiver 3132 at the nextattempt to auto-program the infusion pump. Auto-program complianceinformation is saved in a memory of the pump and, whether or notdisplayed on the pump, can be subsequently transmitted or relayed to thefirst computer, another medical device or infusion pump or a remotecomputer for storage, analysis, display or use.

In one or more embodiments, the at least one infusion pump 3130 maytransmit the at least one manual infusion program from the at least onecaregiver 3132 to the first computer. In at least one embodiment, thefirst computer may save the at least one manual infusion program fromthe at least one caregiver 3132 and may save identification data of theat least one caregiver 3132. In one or more embodiments, the firstcomputer may compare the at least one manual infusion program from theat least one caregiver 3132 to the at least one stale auto-program todetermine a scoring of accuracy or effectiveness. In at least oneembodiment, the scoring of accuracy may include an acceptability levelof the at least one manual infusion program from the at least onecaregiver 3132.

By way of one or more embodiments of the invention, the first computermay generate at least one report from the comparison of the at least onemanual infusion program to the at least one stale auto-program. In atleast one embodiment, the report generated by the first computer mayinclude one or more of a time differential between completion time ofthe at least one manual infusion program and completion time of the atleast one stale auto-program, a scoring of accuracy including anacceptability level between infusion administration parameters of the atleast one manual infusion program and the at least one staleauto-program, and a rating of the at least one caregiver 3132.

FIG. 4 illustrates an enhanced view of the exemplary infusion pump 3130comprising display screen 88. The exemplary screens provided in FIGS. 5and 6 may be displayed at display screen 88. The infusion pump 3130 maydisplay error messages, error codes, and suggested actions at displayscreen 88. The display screen 88 includes a plurality of areas orregions such as a status region 88A, a working region 88B, and a messageregion 88C. The pump may comprise a memory, a processor, a clock (realtime or otherwise) and other components. The memory may storecomputer-executable program instruction. Moreover, the processor mayexecute the computer-executable program instructions, which may causethe processor to perform one or more steps recited in the presentdisclosure.

FIGS. 5 and 6 illustrate exemplary flow diagrams for displaying errormessages at display screen 88. Prior to turning on the multi-channelinfusion pump 3130, a cassette may or may not first be required to beinstalled in the infuser. A caregiver 3132 may install the cassette intothe door of pump 3130 and then close the door. Next, the nurse may turnon the infusion pump 3130 by pressing an ON/OFF button, such as theON/OFF button 405 shown in FIG. 4 . After the ON/OFF button 405 ispressed, infusion pump 3130 may begin its startup process. After thestartup process, which may take up to a few minutes, the infusion pump3130 may be prepared to accept an auto-programming request.

At this point, infusion pump 3130 may display screen 501. Display screen501 may be referred herein as the A/B screen or home screen. As shown inFIG. 5 , screen 501 may display (in the working region 88B or elsewhere)delivery information for channel A and channel B, such as the rate andvolume infused or volume to be infused (VTBI). Because anauto-programming request has not yet been received, the initial valuesfor the delivery information may be set at 0 as shown in screen 501. Thehome screen 501 may also display a selected CCA (here shown directlybelow the Volume Infused or Volume To Be Infused (VTBI) as “ICU,” whichrepresents an intensive care unit). Home screen 501 may also displayinstructions or suggested actions that could be taken by a caregiver3132. For example, screen 501 may initially display suggested action“Select Line A/B to program” as shown in FIG. 5 . The suggested actionmay alert the caregiver 3132 of the next steps to be taken in order tosubmit a manual or an auto-program request. In certain aspects, infusionpump 3130 may display the suggested actions at screen 88 in a differentcolor and/or with different shading than other information displayed onthe screen. Exemplary screens shown in FIGS. 5 and 6 , for example,display the suggested actions in white text with black shading incontrast to other information displayed in black text and white shading.Moreover, the suggested actions may be displayed in a particularsection, region or area of each screen, such as in the message regionnear the bottom of each screen shown in FIGS. 5 and 6 .

The screens displayed at the infusion pump 3130 may include otherindicators, such as a battery life indicator 563 (which may indicate theamount of battery life remaining for the pump 3130), a wireless signalindicator 565 (which may indicate the strength of the wireless signalconnection at pump 3130), and a two-way arrow 561 (which may indicateconnection between the MMU and the pump and thus the capability of pump3130 to upload and download information to and from the MMU server3108).

Screens, as shown in FIGS. 5 and 6 , may further comprise various inputoptions. The input options may be presented in a row at the bottom ofthe screen (such as directly below the suggested actions as shown inFIGS. 5 and 6 ). Each input option may be an option that may be selectedby a caregiver 3132. In some aspects, the caregiver 3132 may touch thescreen itself to select an input option, and in other aspects, thecaregiver 3132 may select a corresponding soft key or button directlybelow the input option. See the triangles below the screen 88 and theinput options in FIG. 4 . Other options and text, such as “OK”,“Continue”, “Reject”, “Yes”, “No”, “Standby”, “Standby Confirmation”,“Delay Start”, “Return to A/B”, etc. may be displayed in the messageregion 88C and selected by caregiver using a touchable screen or thecorresponding soft key below the displayed option or text. In responseto the display at screen 501 and the suggested action “Select Line A/Bto program”, caregiver 3132 may select either input option “A”, inputoption “B”, or input option “Settings/Vols/CCA”. Selecting option“Settings/Vols/CCA” may cause infusion pump 3130 to display a screen inwhich caregiver 3132 may edit settings, the way volume is displayed(volume infused versus volume to be infused or VTBI), or a CCA for theinfusion pump 3130. Selecting either option “A” or “B” may initiate theauto-program sequence for that selected channel.

At step 551, infusion pump 3130 may determine whether anauto-programming request has been received. In other words, infusionpump 3130 may determine whether the steps described with respect toFIGS. 1-3 have been performed, particularly steps 201, 203, 205, 207,209, and 211.

At step 553, the infusion pump 3130 may determine whether it needs tochange the auto-program drug order to “No Drug Selected”. The analysisperformed at step 553 is an example of the various analyses that may beperformed when the infusion pump 3130 verifies the infusion programsettings against the installed drug library at step 213. Thus, as thepump 3130 performs its verification step 213, one of the plurality ofverification actions it may perform may include determining whether themedication selected by caregiver 3132 is stored in the drug library forthe selected CCA. For example, caregiver 3132 may select the CCA “ICU”prior to auto-programming. Then the caregiver 3132 may select or scanmedication using POC client 3126 at step 203. After pump 3130 receivesthe auto-programming request for the ICU CCA, pump 3130 may verify theprogram settings against installed settings stored in its drug libraryat step 213. One of the verification steps may include determiningwhether the selected or scanned medication is included among themedications stored in the drug library for the ICU CCA. In other words,a processor of the pump 3130 makes a comparison between the drug name,concentration and dosing units provided in the auto-programming requestto the same parameters in the drug library for the particular clinicalcare area selected or active on the pump. If, in the drug library, theselected medication is not among the listed medications available forthe ICU CCA, pump 3130 may be programmed to output “No Drug Selected” asa substitution alert error message. At step 553, if the pump 3130determines that it must change the order to “No Drug Selected”, it maydisplay an error message such as screen 503.

The error message may comprise a brief description of the error so thatthe caregiver 3132 may be able to quickly determine the cause of theerror at the pump 3130 and perform subsequent actions in response to theerror. In the example provided at screen 503, processor of the pump 3130may perform a drug name, concentration, dosing units, or drug IDcomparison against the drug list in the drug library on the pump for theselected clinical care area or CCA and display at display screen 88 theerror message “The Auto-Program contains a medication which is notavailable in the CCA (ICU)” and “For this order the medication ‘No DrugSelected’ has been substituted”. The pump 3130 may display a“Substitution Alert” in the status region or elsewhere on screen 503 tonotify caregiver 3132 that an error has occurred. The error message maythen notify the caregiver 3132 of the precise cause of the error (here,the selected CCA and the fact that the auto-program contained amedication that, pursuant to the hospital's best practices as set forthin the customizable drug library, is not planned to be available in theCCA). The error message may also, in some aspects display the actionstaken by the pump 3130 in response to the error (here, “No DrugSelected” has been substituted for the medication by the processor ofthe pump because it found no match for the medication in the druglibrary entries for the selected CCA).

Also shown in the message region or elsewhere on the screen 503 is thesuggested action “Continue with no drug selected or Reject program”. Thesuggested action may notify caregiver 3132 that s/he should eitherselect the input option “Continue” in order to continue the auto-programrequest with no drug selected substituted for the medication, or selectthe input option “Reject” to cancel the auto-program request. The inputoptions may be displayed immediately below the suggested action, asshown in screen 503. If the caregiver 3132 selects the “Reject” option,pump 3130 may deny the auto-program request and display a previousscreen such as home screen 501. A message concerning the rejection ofthe auto-program request may be sent to the MMU server 3108, which thenrelays the message to the POC system 3125. In certain aspects, screen503 may be displayed for a predetermined amount of time, such as about30 seconds. If no response or input option is selected within thatpredetermined amount of time, pump 3130 may automatically reject theauto-programming request and display screen 501. If, instead, thecaregiver 3132 selects the “Continue” input option, pump 3130 maydisplay screen 505 where the rest of the auto-programmed deliveryinformation is pre-populated on the pump screen 88 in the working region88B or elsewhere as shown on screen 505. At screen 505, caregiver 3132may edit the delivery information, such as rate, VTBI, and duration.Screen 505 may continue to display “No Drug Selected” in or near thestatus region 88A at the top of the screen and a suggested action “Entervalue using keypad” in the message region 88C at the lower portion ofthe screen 88. Pump 3130 may also highlight the field that may have itsvalue edited (here, e.g., “500” for VTBI in mL) or do so when activatedby touch or other keys. The caregiver 3132 may enter these values on thekeypad 401 provided at the pump 3130, as shown in FIG. 4 .

At step 555, pump 3130 may determine if the start button 403 (FIG. 4 )has been selected or pressed by the user. If so, pump 3130 may display ascreen such as screen 507. The screen 507 may correlate with step 217 inwhich the caregiver 3132 verifies the infusion program settings werecorrectly populated. Caregiver 3132 may select input option “No” toreturn to screen 505 and edit one or more of the displayed deliveryinformation values. Alternatively, caregiver 3132 may select the“Standby” input option to standby for a predetermined or configurableperiod of time to await confirmation of the medication delivery. If the“Yes” input option is selected, pump 3130 may start the infusion programat step 219 and may display screen 509. Screen 509 may notify thecaregiver 3132 that medication is pumping on the selected channel (here,channel A) at the selected rate (here, 250 mL/hr) and display a currentVolume Infused (here, 0.1 mL). Screen 509 may also display the suggestedaction “Select Line A/B to program”, which may enable the caregiver 3132to edit or submit another auto-program request for channel A or B. Incertain aspects, channel A may be a primary channel for administeringmedication and channel B may be a secondary line for administeringmedication.

FIG. 6 illustrates another example of a flow diagram of screensdisplayed at pump 3130. The series of screens shown in FIG. 6 begins atscreen 601, which may be similar to screen 509 shown in FIG. 5 . In theexample provided in FIG. 6 , a caregiver 3132 may request anauto-program at pump 3130 even as channel A is pumping. Here the pump3130 is pumping Dopamine, a commonly prescribed vasoactive medicationfor controlling blood pressure. Dopamine is prescribed based on thepatient's weight, which in this example is 70 kg. The Dopamine issupplied at a concentration of 400 mg in a 250 mL container. Theprescribe dose is 5.0 mcg/kg/min, which the pump converts to a rate of13.1 mL/hr. The pump 3130 has pumped 240 mL so far. Similar to step 551of FIG. 5 , the pump 3130 may determine in step 651 whether anauto-programming (AP) request has been received for channel A. Therequest may be received after steps 201, 203, 205, 207, 209, and 211have been performed. At step 213, pump 3130 may verify infusion programsettings against program settings stored in the drug library. In someaspects, pump 3130 may further verify the infusion program settingsagainst settings hard-coded into the pump. The verification step 213 ofFIG. 2 or FIG. 3 may comprise step 653 of FIG. 6 , in which pump 3130may determine whether the auto-program request for channel A is for thesame medication or an acceptable alternative to the medication currentlybeing delivered at channel A. In one aspect, the concept of the “samemedication” can comprise the same medication by name (generic or brand),and one or more of concentration and dosing units. If the medication inthe auto-program request for channel A is Dopamine, it might be okay andnot trigger a mismatched medication/concentration error (code MCD00006in Table 1 above). However, if the pump determines in step 653 that adifferent or non-equivalent medication is specified in the auto-programrequest received in step 651, such as Morphine for example, the pump3130 displays the error message shown on screen 603.

Screen 603 may display “Rejection Alert” in the status region or anotherregion of the screen to notify caregiver 3132 of an error. Screen 603may also display the error message, such as “The Auto-Program receivedcontained a medication which is different from what is delivering on theprogrammed line” in the working region or another region. Thus, thecaregiver 3132 may be notified at the pump 3130 that there has been anerror and the cause of the error. In some aspects, this error messagemay also display the medication that is being delivered on the channel,and/or other information such as the concentration and or dosing unitsof the medication order. For example, the error message at screen 603may display “The Auto-Program received contained a medication [Morphine]which is different from [Dopamine] that is delivering on the programmedline” or “The Auto-Program received contained a medication which isdifferent from the [Dopamine 400 mg/250 mL] that is delivering on theprogrammed line”. Screen 603 may also display the suggested action forthis error message in the message region or another region, in this case“Reject this order now, or wait for automatic rejection?” Pump 3130 mayprovide one or more one input options at screen 603, e.g., an option toreject the auto-program order. Caregiver 3132 may select the “Reject”option to return to screen 509. Alternatively, caregiver 3132 may notselect an input option at all, in which case pump 3130 may automaticallyreject the auto-program order after the timeout period, such as about 30seconds.

If, at step 653, pump 3130 determines that the medication in theauto-programming request is the same or equivalent as the medicationcurrently pumping on channel A, or that the at least one manual infusionprogram is acceptable, pump 3130 may display screen 605. Similar toscreen 505, discussed above, screen 605 may enable a caregiver 3132 tomodify the settings of the delivery information values, such asconcentration, rate, VTBI, and duration. Also shown at screen 605 is aninput option “Delay Start”. A caregiver 3132 may select the “DelayStart” input option in order to select a later time in which to beginpumping of the auto-program medication. Alternatively, caregiver 3132may select the “Return to A/B” input option to return to screen 509.

At step 655, pump 3130 determines if the start button 403 (as shown inFIG. 4 ) has been selected. If so, pump 3130 may display screen 607.Caregiver 3132 may be able to review the information displayed at screen607, similar to screen 507 as discussed above. Caregiver 3132 may thenselect the “Yes” input option to verify that the infusion programsettings were correctly populated at step 217. In response, pump 3130may start the infusion program at step 219 and the infusion pump 3130may display screen 609.

Some other examples of error messages that may be displayed by the pump3130, for example at screens such as screens 503 and 603, will now bediscussed in further detail. In certain aspects, pump 3130 may determinean error at step 213 without any outside intervention from, for example,MMU, HIS, BCMA, EMR, and the POC system. In some cases, pump 3130 mayallow an auto-programming order to continue after displaying an errormessage. Pump 3130 may also notify parties, such as MMU, HIS, BCMA, EMR,and the POC system of an error and the error message that was displayed.Those of ordinary skill in the art will appreciate that the errormessages disclosed herein are exemplary, and may be modified withoutveering from the scope of this disclosure.

Pump 3130 may display an error message such as associated with errorcode NTA00003 in Table 1 above, “The auto-program received containsduration information, and you cannot titrate the duration of a deliverywith this dosing unit”. This error message will be displayed when theinfuser receives an auto-program message with a titrated duration valueand is for a medication that normally has time-based alternative dosingunits. For example, if the drug involved in the program has time-basedalternative dosing units the caregiver is not allowed to change theduration because such an action would change the associated dose.Examples include but are not limited to vasoactive drugs likenitroglycerin or Dopamine dosed in mcg/kg/min, anti-coagulants likeHeparin dosed in units/kg/hour, diabetes control drugs like Insulindosed in Units/kg/day, and oncolytic drugs like Taxol dosed inmg/m2/day. The particular drugs or categories of drugs for which thistype error is generated can be established by the hospital according totheir preferences in their user customizable drug library. On the samescreen, pump 3130 may display the suggested action, e.g., “Press OK now,or wait for this screen to automatically dismiss”. After selection ofthe “OK” input option or waiting for the screen to automatically dismissafter the timeout period, pump 3130 may display the home A/B screen.

In some aspects of the disclosure, pump 3130 may display an errormessage such as “The auto-program received did not contain all requiredinformation”. Generally, the auto-programming message should include ata minimum the following information: pump channel, drug name andconcentration. If one or more of these elements, parameters or settingsis missing, the above-mentioned error message is displayed. On the samescreen, pump 3130 may display the suggested action, e.g., “Press OK now,or wait for this screen to automatically dismiss”. As discussed above,after selection of the “OK” input option or waiting for the screen toautomatically dismiss after the timeout period, pump 3130 may displaythe home A/B screen.

Pump 3130 may be programmed to generate and display an error messagesuch as “The auto-program received contains a value that exceeds asystem limit. Or the values cause a calculated parameter to exceed asystem limit.” One or more system limits may be hard-coded into pump3130 and/or included in the drug library. The system limits may pertainto a rate. For example, the pump 3130 may be able to pump at a maximumrate of 999 mL/hr. If an auto-program request is received at a rategreater than 999 mL/hr., for example say 2000 mL/hr., pump 3130 maydisplay the error message. Similar system limits may exist for otherinformation such as duration, VTBI, and the like. Along with the errormessage, pump 3130 may display the suggested action, e.g., “Press OKnow, or wait for this screen to automatically dismiss”.

In some instances, pump 3130 may display an error message such as “Theauto-program is for a line that contains unconfirmed programming data”.This might happen if the caregiver got called away on an emergency tohelp another patient or co-worker before confirming the programmingdata. Pump 3130 may also display the corresponding suggested action“Resubmit the auto-program. All unconfirmed data will be cleared.” Thus,in response to the error message, caregiver 3132 may either resubmit theauto-program or reject the auto-program. If the user elects to resubmitthe auto-program, all of the unconfirmed data previously entered will becleared and thereafter replaced with the data from the resubmittedauto-program. If the caregiver rejects the auto-program, the unconfirmeddata will be maintained and the user is taken to the last input screenused or the home A/B screen.

Pump 3130 may generate an error message at screen 603 stating “Theauto-program is rejected because of a partially programmed line.” A lineis partially programmed when a drug is selected for the line and theline program has not been cleared or confirmed. A pump with an installedcassette was started. The CCA was selected. A new IV bag containing thesame or different drug was hung. The user manually selects one of thelines and a medication on the pump. The user then switches part waythrough the programming sequence to the auto-program process, whereinthe barcode on the drug container is scanned and the order sent. Thestandard auto-program for line A is sent to the infuser, which rejectsthe auto-program because a manual program was already partially input.On the same screen, the suggested course of action is displayed: “Press[Clear] and resubmit the auto-program. All unconfirmed data will becleared.”

Caregiver 3132 may select a “Standby” input option at pump 3130 for aparticular channel. The standby input option is selected to suspend foran indefinite time, up to 72 hours, an infusion that has already beenprogrammed on a particular channel or infusion line. The standby optioncan be used prior to an infusion being started if the caregiver isunsure of the time the infusion should be started. For example, thecaregiver can set up the pump and it can be programmed, but the patientmay not yet be present at their bed. However, unlike the delayed startoption which inserts a predetermined delay prior to the start of aprogrammed infusion, the standby option also can be selected during theexecution of a programmed infusion. It would be undesirable in mostcases for a previously programmed and started infusion program to beautomatically supplanted by a new set of infusion pump settings throughan auto-programming message or request. Thus, the pump 3130 may notaccept an auto-program request for a channel or line that is already instandby mode. When a request is received for a line in standby, pump3130 may display an error message such as “The auto-program is for aline which is in Standby”. Similarly, pump 3130 may not accept anauto-program request for a channel or line that is “Delay Start” mode.As discussed above, “Delay Start” may enable a caregiver 3132 to inputauto-program settings to be started automatically at a later time (Xnumber of minutes or hours later), wherein the later time may bepredetermined, known and selected by the caregiver 3132. If pump 3130receives a request for auto-program on a line which is in “Delay Start”mode, pump 3130 may display an error message such as “The auto programis for a line which is in Delay Start”. For both the Standby and DelayStart error messages, pump 3130 may display a suggested action, e.g.,“Clear this line and resubmit the auto-program”. This suggested actionmay advise the caregiver 3132 to clear the line that is in either“Standby” or “Delay Start” mode and then resubmit the auto-programrequest.

Pump 3130 may display the error message “The auto-program is for a linethat has an active alarm that stops or prevents delivery, thus theauto-program is not valid in this alarm condition.” Pump 3130 may becapable of outputting alarms for various situations or conditions. Forexample, the pump 3130 battery may be almost dead and not plugged in toa power source. In another example, a high priority alarm may be inprogress. During these situations, pump 3130 may not accept anauto-program request and, along with the error message, may display thesuggested action “Clear the alarm condition and resubmit theauto-program”. Clearing the alarm may comprise eliminating the conditioncausing the alarm (such as replacing or charging the pump battery).

Because of the unique concurrent delivery capabilities of the PLUM™infusion pump, two different medications can be delivered from twodifferent source containers upstream of the pump, effectively at thesame time through a single line to the patient downstream of the pump.The pump can also switch back and forth from delivering medication fromlines A and B respectively, and vice versa, making separate butcoordinated “piggyback” delivery possible and convenient. However, thiscan lead to some rather complex scenarios from an auto-programmingperspective. Many things can go wrong and lead to errors, includingfailures, unintended consequences or problems. Previously many of theseerrors would not have been communicated to the caregiver at the pump oron its display screen. Recall from above that the pump may have a ratelimit of 999 mL/hr. The pump may have certain low flow limitations too.Thus, in certain aspects, pump 3130 may display an error message such as“The auto-program is not valid due to concurrency violation. DeliveryA+B greater than 500 mL/hr or less than 0.5 mL/hr for each line.”Although the pump is physically capable of 999 mL/hr. through a singleline, when concurrent delivery is taking place through two lines (A andB) only 500 mL/hr. is permitted for each of the lines A and B.Otherwise, if each line were to be programmed to deliver 500 mL/hr. ormore, the pump system rate limit of 999 mL/hr. would be exceeded. Also,each line must also be programmed to deliver at least 0.5 mL/hr. or morefor proper pump operation. As discussed above, on the same screen, pump3130 may display the suggested action, e.g., “Press OK now, or wait forthis screen to automatically dismiss”. For greater clarity to the pumpuser, the specific cause for the concurrency violation could bespecified. For example, the error message could read “Delivery of A+Bgreater than 500 mL/hr” or “Delivery A+B less than 0.5 mL/hr” dependingupon the specific cause. Concurrency errors can result from varioussituations as well. For example, an auto-program can be rejected for aconcurrency violation when a new IV bag or container or rate change isrequested for Line A or Line B when B is running in concurrent, whichwould result in a concurrency violation, i.e., delivery greater than 500mL/hr. for the sum of the two lines or less than 0.5 mL/hr. on eachline. Alternatively a concurrency violation can happen on the firstattempt to program an initial concurrent delivery on Line B. The errormessages can be tailored to more clearly indicate the specific situationthat caused the rejection of the auto-program.

In some aspects, infusion pump 3130 may be configured to pump primarymedications through line A and secondary medication through line B in aseparate but coordinated piggyback delivery in series. In some cases, anauto-program request for line B may cause an interruption to the pumpingmedication in line A. This may be undesirable, particularly when themedication pumping in line A is vital such as critical medicationsincluding but not limited to Dopamine, Heparin or Insulin. Thus, whenthe infusion pump 3130 receives an auto-program for line B in step 651,the infusion pump 3130 may at step 653 make a determination whether amedication on that or another line is interruptible. If the answer isaffirmative, then the process can continue to screen 605, step 655, etc.If the answer is negative, the pump 3130 can display an error message atscreen 603 such as “The auto-program is not valid for line B. Themedication delivering for line A cannot be interrupted.” Similarly,infusion pump 3130 may display an error message such as “Theauto-program is not valid for line A. The medication in the Auto-Programis not interruptible and Line B is delivering a Piggyback infusion.”Correspondingly, pump 3130 may display the suggested action “Press OKnow, or wait for this screen to automatically dismiss”.

Pump 3130 may display the same suggested action on a screen with anerror message such as “The auto-program is not valid because the weightof the patient in the Auto-Program does not match the weight of thepatient on the program delivering on the other line.” The infusion pump3130 may generate this or similar error message when the weight orexpected weight range entered for a patient is inconsistent among themultiple lines. For instance, a nurse may enter a weight of 75 kg for apatient on line A and then a weight of 7.5 kg for the same patient online B. These inconsistent weights may cause infusion pump 3130 todisplay the error message. Similarly, pump 3130 may display an errormessage such as “The auto-program is not valid because the height of thepatient in the auto-program does not match the height of the patient onthe program delivering on the other line.” In this case, pump 3130 mayensure that the height or expected height range of the patient receivingmedication is consistent on line A and line B. Similarly, pump 3130 maydisplay an error message such as “The auto-program is not valid becausethe BSA in the auto-program does not match the BSA on the programdelivering on the other line.” BSA means body surface area and isusually estimated or calculated based on a patient's body mass andheight. BSA is also sometimes expressed as BMI or body mass index andsome drugs are dosed on this basis.

As discussed previously, a caregiver 3132 may be required to enter a CCAprior to programming the pump 3130 manually or submitting anauto-program request. If no CCA is received or a CCA not stored in thedrug library is received, infusion pump 3130 may display an errormessage such as “The Auto-Program is not valid because a CCA has notbeen selected on the infuser.” Pump 3130 may also suggest the action,e.g., “Select a CCA and resubmit the Auto-Program”.

Pump 3130 may comprise a lock to the keypad shown in FIG. 4 . When thekeypad is locked, pump 3130 may not receive commands submitted byselecting buttons on the keypad. Pump 3130 also may not receiveauto-programming requests when the keypad is locked. In those cases,pump 3130 may display an error message such as “The auto-program is notvalid because the keypad is locked.” The infusion pump 3130 may alsodisplay the suggested action, e.g., “Unlock the keypad.” After caregiver3132 unlocks the keypad, pump 3130 may automatically accept theauto-programming request.

The remaining error messages discussed below may be displayed inconjunction with the suggested action, e.g., “Press OK now, or wait forthis screen to automatically dismiss”. As discussed above, afterselection of the “OK” input option or waiting for the screen toautomatically dismiss after the timeout period, pump 3130 may displaythe home A/B screen.

Pump 3130 may, in some cases, generate and display an error message suchas “The Auto-Program is not valid because the received parameters willnot result in a valid dose.” When two out of the three parameters orvariables volume, (flow) rate and duration are provided to the pump3130, its processor can calculate a dose. Normally when a certain dosageis being targeted or ordered by the doctor, it is based upon the weightof the patient. The drug may be available as an amount or mass in agiven volume of diluent such as 5 mg/1000 mL IV container. When there isno combination of values of flow rate and duration that will result in avalid dose, this error message is generated.

Infusion pump 3130 may display an error message such as “Theauto-program is not valid because the Rate cannot be titrated when VTBIis 0.” This error message may be displayed when a caregiver 3132 entersa rate for a medication to be pumped while also entering a total volumeof the medication to be infused of 0 mL. Pump 3130 may therefore requirea VTBI greater than 0. The auto-program might be a change to a currentlyrunning program—a “titration.” However, if there is no VTBI left toinfuse in the program, the rate or other parameters cannot effectivelybe changed because there is no volume left to be infused. Similarly,infusion pump 3130 may display an error message such as “Theauto-program is not valid because it is a titration for a line that hasno confirmed program.” A titration is by definition a change in rate,duration or VTBI in a currently running or already programmed infusion.Thus, you cannot auto-program a titration or change for a line or pumpchannel until after it has a prior program that has been confirmed.

In certain aspects, pump 3130 may display an error message such as “Theauto-program is not valid for a line with a Multistep or Loading doseprogram.” If the line is busy with a multistep infusion or loading doseprogram, that program must be completed or cleared before any newauto-program request can be received and executed.

Infusion pump 3130 may display an error message such as “TheAuto-Program was rejected by Hospira MedNet due to incomplete or corruptdata.” This might be highlighted by a checksum failure or handshakefailure. Part of the auto-program message may have been lost orcorrupted for one reason or another.

Pump 3130 may display an error message such as “The Auto-Program forthis infuser was rejected by Hospira MedNet™ due to drug libraryincompatibility.” The drug library identified in the device manifest forthe auto-program message is not recognized. In other words, the activedrug library mentioned in the auto-program manifest does not match whatthe MMU server 3108 and/or the pump itself thinks is the appropriatedrug library that is in the pump. For example, the drug library has anidentifier (perhaps an alphanumerical string) that may include the pumptype and version of the drug library. For some reason, the drug libraryversion may get out of synch between the infusion pump and the MMU suchthat drug library identifier in the auto-program request does match thedrug library that is currently in the infusion pump.

FIG. 7 illustrates a flow chart of a process 700 in accordance withaspects of the disclosure. Process 700 may be carried out using infusionpump 3130 shown in FIG. 4 . Step 701 may comprise receiving anauto-programming request, wherein the auto-programming request maycomprise IV bag or drug container information such as drug name,concentration or other drug identifying information, and infusion pumpinformation, and optionally patient identification information. Step 703may comprise receiving infusion program settings, parameters orvariables including but not limited to dose, flow rate, duration andvolume. Step 705 may comprise comparing the infusion program settingswith drug library program settings, wherein the drug library programsettings are included in rule sets that place soft (breachable) limitsand hard (non-breachable) limits provided in a drug library stored atthe infusion pump. Step 707 may comprise determining whether theinfusion program settings are consistent or inconsistent with the druglibrary program settings based on the comparing.

Step 709 may comprise generating an error message based on thedetermining that the infusion program settings are inconsistent with thedrug library settings. Step 711 may comprise displaying a screen,wherein the screen comprises the error message and a suggested action.In some aspects, other steps may be performed as discussed above inconnection with FIGS. 1-6 .

In at least one embodiment of the invention, if the infusion programsettings are consistent with the drug library program settings based onthe comparing, at step 713 the at least one infusion pump 3130 comparesthe at least one stale auto-program received to the at least onecompleted or running manual infusion program based on an approximatetime of infusion administration and parameter matching logic includinginfusion administration parameters and infusion pump operatingparameters, to determine if the at least one previously completed orrunning manual infusion program is acceptable based on the potentialmatches as discussed previously.

At step 715, in one or more embodiments, the at least one infusion pump3130 saves the acceptably completed or running manual infusion programsfor later analysis. In at least one embodiment, at step 715, the atleast one infusion pump may optionally notify the at least one caregiver3132 of the acceptable at least one completed or running manual infusionprogram instead of the at least one auto-program as the acceptableprogram.

It will be apparent to those skilled in the art that numerousmodifications and variations of the described examples and embodimentsare possible in light of the above teaching. The disclosed examples andembodiments are presented for purposes of illustration only. Otheralternate embodiments may include some or all of the features disclosedherein. For example, the first computer can be in the HIS/POC or othercomputer system inside or outside the healthcare facility such that theMMU 3108 is not required to communicate with the infusion pump 3130.Therefore, it is the intent to cover all such modifications andalternate embodiments as may come within the true scope of thisinvention.

What is claimed is:
 1. An infusion pump configured to communicate with afirst computer using a computer network interface, the infusion pumpconfigured to: receive a first manual infusion program comprising firstinfusion program settings from a caregiver, execute said first manualinfusion program, receive a stale auto-program comprising secondinfusion program settings, wherein the stale auto-program was previouslyunable to be transmitted to the infusion pump, determine differencesbetween said first infusion program settings of said first manualinfusion program and said second infusion program settings of said staleauto-program; generate a rating for the caregiver based on thedifferences; and determine if a second manual infusion program from thecaregiver is acceptable based at least partially on the rating for thecaregiver.
 2. The infusion pump of claim 1, wherein the infusion pump isfurther configured to display the rating for the caregiver.
 3. Theinfusion pump of claim 1, wherein said first manual infusion program isprovided in a drug library stored at said infusion pump.
 4. The infusionpump of claim 1, wherein said infusion pump is further configured tosave said differences between said first infusion program settings ofsaid first manual infusion program and said second infusion programsettings of said stale auto-program to a remote server.
 5. The infusionpump of claim 1, wherein said infusion pump is further configured tosave identification data associated with said caregiver.
 6. The infusionpump of claim 1, wherein said infusion pump is further configured todetermine a scoring of accuracy based on said differences between saidfirst infusion program settings of said first manual infusion programand said second infusion program settings of said stale auto-program,wherein said scoring of accuracy comprises an acceptability level ofsaid first manual infusion program.
 7. The infusion pump of claim 1,wherein said infusion pump is further configured to generate a reportfrom said differences between said first infusion program settings ofsaid first manual infusion program and said second infusion programsettings of stale auto-program, and wherein said report comprises one ormore of a time differential between a completion time of said firstmanual infusion program and a completion time of said staleauto-program, a scoring of accuracy comprising an acceptability level ofsaid first manual infusion program and said stale auto-program, and therating of the caregiver.
 8. The infusion pump of claim 1, wherein saidinfusion pump is further configured to transmit said first manualinfusion program to said first computer, and wherein said first computeris further configured to save said first manual infusion program andidentification data of the caregiver.
 9. The infusion pump of claim 1,wherein said infusion pump is further configured to compare said firstinfusion program settings of said first manual infusion program to saidsecond infusion program settings of said stale auto-program to determinea scoring of accuracy comprising an acceptability level of said firstmanual infusion program.
 10. The infusion pump of claim 1, wherein saidinfusion pump is further configured to verify the first infusion programsettings against a drug library installed on the infusion pump.
 11. Theinfusion pump of claim 1, wherein said stale auto-program furthercomprises fluid container information and infusion pump information. 12.The infusion pump of claim 1, wherein the first infusion programsettings or the second infusion program settings comprises infusion pumpoperating parameters, a volume to be infused, or a rate of delivery. 13.A method for identifying an acceptable manual infusion program at aninfusion pump comprising: receiving a first manual infusion program froma caregiver, executing said first manual infusion program, receiving astale auto-program from a first computer, comparing one or more infusionparameters of said stale auto-program to corresponding one or moreinfusion parameters of said first manual infusion program, determining,based on the comparing, differences between the stale auto-program andthe first manual infusion program, generating a rating for the caregiverbased on the differences, and determining a second manual infusionprogram from the caregiver is acceptable based at least partially on therating for the caregiver.
 14. The method of claim 13, further comprisingdisplaying the rating for the caregiver.
 15. The method of claim 13,further comprising saving said first manual infusion program in a druglibrary stored at said infusion pump.
 16. The method of claim 13,further comprising saving said differences to a remote server.
 17. Themethod of claim 13, further comprising verifying the first infusionprogram settings against a drug library installed on the infusion pump.18. The method of claim 13, further comprising: receiving, via saidfirst computer, an infusion auto-program from a remote source, whereinsaid infusion auto-program comprises infusion program settings; andqueuing said infusion auto-program when said first computer is unable totransmit said infusion auto-program to said infusion pump, wherein saidqueued infusion auto-program becomes the stale auto-program.
 19. Themethod of claim 13, wherein said stale infusion auto-program comprisesIV drug container information, infusion pump information, and infusionprogram settings.